California Program Moves Doctor Report Cards Forward
Private health insurers and federal health care programs are "making California a testing ground for standards that could eventually be used to rate all physicians in the country, rewarding them for keeping people healthy and costs down," the Los Angeles Times reports. Currently, no set of established national standards exists to measure the clinical performance of physicians.
California is a "pioneer with a state system that rates physician groups and financially rewards them with cash prizes for improving preventive care and patient satisfaction," according to the Times. California rates physician groups through a voluntary program launched in 2003 by the Integrated Healthcare Association.
More than 200 physician groups participate, and state officials have said that the program has made $145 million in payments. According to state officials, the program has increased cervical cancer screenings by more than 60,000 among physician groups that participate.
In addition, federal officials this week announced that California will join five other states in a pilot project that could prompt the development of national standards to measure the clinical performance of physicians. The project will analyze claims filed by Medicare beneficiaries, as well as members of the three largest private health insurers in California, to rate the performance of about 25,000 physicians in the state.
Peter Lee, CEO of Pacific Business Group on Health, said, "We pay even if doctors make mistakes, run unnecessary tests and have to redo their work."
However, some physician groups have raised concerns that performance data often is incomplete and that health insurers might use pay-for-performance programs to reward physicians who provide the least expensive care.
Cecil Wilson, chair of the board of the American Medical Association, said, "Our concern is that some of the plans may use efficiency as a code word for cutting costs," adding, "Right now there is no good definition of efficiency, and looking at claims data doesn't tell you the full story."
A study published on Thursday in the New England Journal of Medicine raises "further doubt on whether medical claims could paint a good picture of a doctor's performance," according to the Times.
For the study, researchers from the Center for Studying Health System Change examined claims filed by almost two million Medicare beneficiaries. The study found that, in many cases, "so many doctors had treated a single patient that it was nearly impossible to credit particular physicians for the outcome of the treatment," the Times reports (Yi, Los Angeles Times, 3/15).